title: Spinal anaesthesia for caesarean section in the presence of respiratory failure and spinal metastases from a soft tissue clear cell sarcoma.
abstract: Spinal metastases occur in up to 70% of all patients with cancer. However, only 10% are symptomatic. Before considering central neuraxial blockade in patients with malignancy, a history of back pain should be excluded. Anaesthetists should be aware that intrathecal and epidural injections could cause paraplegia if metastases are impinging on the spinal cord. Failure to achieve adequate sensory anaesthesia after central neuraxial blockade or presentation with postoperative paraplegia may indicate the presence of asymptomatic vertebral canal metastases. In this report, the anaesthetic management of a patient with respiratory failure and spinal metastases from a soft tissue sarcoma, requiring caesarean section is described. Sensory anaesthesia extending above a level of imminent cord compression was achieved despite loss of cerebrospinal fluid signal on magnetic resonance imaging.
authors.affiliation: Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK. aliceshorthouse@doctors.org.uk
authors.forename: A M
authors.initials: AM
authors.lastname: Miskovic
authors.forename: D P
authors.initials: DP
authors.lastname: Dob
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D001034:Apgar Score; D001859:Bone Neoplasms / Q000473:pathology; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D010166:Palliative Care; D011247:Pregnancy; D012131:Respiratory Insufficiency / Q000150:complications*; D018227:Sarcoma, Clear Cell / Q000150:complications / Q000473:pathology / Q000556:secondary*; D013125:Spinal Neoplasms / Q000150:complications / Q000473:pathology / Q000556:secondary*